Public Hearings Set on Landmark Nursing Plan

California, the only state that has agreed to mandate nurse-to-patient ratios in its hospitals, is about to get an earful from its citizens — feedback that could alter its plan and influence healthcare policy in other states where similar legislation is being considered.

The state Department of Health Services is holding the first of three public hearings about the proposed rule, the Safe Staffing Law, on Friday. And some of those who plan to attend the Los Angeles meeting say some of the debate will focus on whether proposed rations can be achieved and the possible use of licensed practical nurses to fill the ratios.

California currently has has the second lowest number of nurses per 100,000 residents. Only Nevada has fewer nurses per capita. If present trends continue, experts predict that California will be short 25,000 registered nurses by 2006. But it will need more than 30,000 more registered nurses to meet the new requirements.

As it stands, the proposed rule would eventually set a ratio of at least one RN for every five patients on general medical floors. The California Healthcare Association, which represents nearly 500 state hospitals, proposed a ratio of one nurse for every 10 patients on those floors. The ratios are set to take effect Jan. 1, 2004.

Lisebeth Jacobs, a registered nurse and a spokeswoman for the California Nurses Association, says the new regulations could be altered if the DHS finds testimony at the hearings compelling enough. The second hearing is scheduled for Nov. 19 in San Francisco, and the third for Dec. 4 in Fresno. Written comments currently can be submitted through Dec. 6.

If the DHS makes substantial changes after the current round of hearings, it will allow a public-comment period of 15 days before it submits a revised plan to the state Office of Administrative Law. Once the Office of Administrative Law approves the plan, it will be filed with the secretary of state and take effect 30 days later.

Several states, including Florida, Iowa, Kentucky, Missouri and New Jersey, will be watching the California hearings closely. They are all considering legislation that would require nurse-to-patient ratios in hospitals and other healthcare facilities, according to the American Nurses Association.

Jan Emerson, a spokeswoman for the California Healthcare Association, says the nurse-to-patient ratio scheme as currently written is too rigid, and will hurt hospital patients more than it will help them.

Nursing ratios need to be set according to the severity of patients’ conditions, she says. “How many require wound care? How many are recuperating from surgery? How many require intravenous medication? How many have chronic conditions, like diabetes, in addition to what is hospitalizing them?” she says.

Administrators also need flexibility that accounts for changes in patients’ conditions as they assess staffing needs, Emerson says.

“California does not allow for that flexibility,” she says, and is trying to “mandate a specific number that must be used every minute of every hour of every day, in every hospital, and in every community.”